PEDIATRIC
ADVANCED LIFE
SUPPORT
2010 Algorithms
Florida Heart CPR*
Wabasso, Florida 32958
866-388-5252
Web: floridaheartcpr.com
Revised January 2011
1
Ventricular Fibrillation and
Pulseless Ventricular Tachycardia
↓
Start high quality CPR
Give oxygen, attach
monitor/defibrillator
↓
As soon as possible,
measure child with
BROSELOW tape
Defibrillate 2j/kg
↓
Continue CPR (no pulse check)
Obtain IV or IO access
↓
Epinephrine
IV/IO: 0.01 mg/kg 1:10,000
*USE BROSELOW DOSE*
Repeat q3-5 minutes
If no IV/IO access, may give
ET dose: 0.1 mg/kg (0.1mL/kg
of 1:1000 concentration
(consider advanced airway with
capnography or capnometry)
↓
Defibrillate 4j/kg
↓
Amiodarone
5 mg/kg
* USE BROSELOW DOSE*
(may be repeated up to 2 times in refractory V-fib/PVT)
↓
Defibrillate 4j/kg
↓
Epinephrine
↓
Defibrillate 4j/kg
↓
Amiodarone
Treat reversible causes
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypoglycemia
Hypo/hyperkalemia
Hypothermia
Tension Pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
5 mg/kg
↓
Defibrillate 4j/kg
Never stop CPR for more than 10 seconds: If organized rhythm check pulse;
if ROSC, start post-cardiac arrest care
Revised January 2011
2
Pediatric Asystole/PEA
Check pulse/begin high quality CPR
↓
Secure Airway
Ventilate with 100% O2
↓
Obtain vascular access, IV or IO
↓
As soon as possible,
measure child with
BROSELOW tape
Epinephrine
IV/IO: 0.01 mg/kg 1:10,000
*USE BROSELOW DOSE*
(ET: 0.1 mg/kg 1:1,000)
↓
Repeat Epinephrine q3-5 minutes
While providing high quality CPR
↓
Consider advanced airway w/capnography
Identify & treat reversible causes:
Hypoxemia
Hypovolemia
Hypothermia
Hyper/hypokalemia
& metabolic disorders
Tamponade
Tension pneumothorax
Toxins/ poisons/ drugs
Thrombosis-pulmonary
Thrombosis-coronary
**Patients who do not respond to several doses of epi with no extenuating
circumstances should be considered for termination.
Revised January 2011
3
Bradycardia
Assess ABCs
Maintain patent airway, assist breathing if necessary
Administer 100% O2
Cardiac monitor, IV/IOaccess
Assess BP, oximetry
↓
Cardiorespiratory compromise?
Acutely altered mental status?
Signs of shock?
NO ←←←←←
→→→ YES
Support ABC’s, oxygen
Observe, consider
Expert consultation
Begin chest compressions if
pulse is ,<60bpm
↓
Epinephrine
*USE BROSELOW DOSE*
IV/IO: 0.01 mg/kg 1:10,000
ET: 0.1 mg/kg 1:1,000
↓
(Repeat Epinephrine q3-5 minutes)
↓
For increased vagal tone or primary AV Block:
Atropine
(Max single dose: 0.5 mg for child)
Consider transthoracic/transvenous pacing
Treat underlying causes
Toxins
Tamponade
Tension Pneumothorax
Thrombosis
Trauma
Revised January 2011
Hypoxia
Hypoglycemia
Hypothermia
Herniation of brain stem
Heart Transplant
4
Stable
Ventricular
Tachycardia
Unstable
Ventricular
Tachycardia
(Child has normal v/s)
(w/signs of poor perfusion)
Assess ABCs
↓
Secure airway
Administer oxygen
↓
EKG and pulse oximeter
Assess vital signs
↓
Establish IV/IO
Labs
↓
Consider
ADENOSINE*
*USE BROSELOW DOSE*
Assess ABCs
↓
Secure airway
Administer oxygen
↓
EKG & pulse oximeter
Assess vital signs
↓
Establish IV/IO
Labs
↓
Assemble code/suction equipment
↓
Immediate synchronized
cardioversion
0.5- 1.0 j/kg
if wide/regular QRS
(monomorphic)
↓
Expert consultation
advised; consider
 Amiodarone
 Procainamide
If unsuccessful, increase to 2j/k
↓
(sedate if needed, but don’t delay
cardioversion)
↓
Consult pediatric cardiologist!
Details/doses
Wide (>0.09 sec)
Amiodarone IV/IO dose:
Narrow (< or = 0.09 sec)
5mg/kg over 20-60 min.
Adenosine IV/IO dose:
Procainamide IV/IO dose:
1st dose: 0.1 mg/kg, max 6mg 15mg/kg over 30-60 min.
2nd dose:0.2 mg/kg max 12 mg Do not routinely administer
Amiodarone and
Procainamide together
Revised January 2011
5
Unstable
Stable
Supraventricular
Tachycardia
Supraventricular
Tachycardia
Assess ABCs
↓
12 Lead EKG
Administer oxygen
↓
Vital signs, IV/IO, Labs
↓
Consider vagal maneuvers
↓
Adenosine*
0.1mg/kg IV rapidly
followed by rapid flush
(may double dose and repeat)
↓
Consider synchronized
cardioversion or alternate
medication
↓
Consult pediatric cardiologist
Assess ABCs
↓
12 Lead EKG
Administer oxygen
↓
Vitals, IV/IO, Labs
↓
Consider vagal maneuvers
↓
Immediate synchronized
cardioversion
0.5- 1.0j/kg
Sedate if possible (but do not
delay cardioversion)
OR
Adenosine*
0.1 mg/kg IV rapidly
followed by rapid flush
may double and repeat
*USE BROSELOW DOSE
Details
Probable sinus tachycardia:
Compatible history consistent
with known cause
P Waves present/normal
Variable R-R; constant PR
Infants: rate usually < 220/min
Children: rate usually < 180/min
Search for and treat reversible causes
Revised January 2011
Probable supraventricular tachycardia
Compatible history (vague, non-specific)
History of abrupt rate changes
P waves absent/abnormal
HR not variable
Infants: rate usually >220/min
Children: rate usually >180/min
Consider vagal maneuvers, consider Adenocard
If IV/IO access not available, or if adenosine not
effective, synchronized cardioversion
6
**CONSULT BROSELOW FOR DOSES*